A second term for President Bush is likely to be a mixed bag for hospitals when it comes to Medicare and other health policy issues, industry officials and observers said last week.
In the plus column, Bush will continue to advance the cause of improving information technology to boost safety and save money. He has pledged to expand coverage through health savings accounts and tax credits. With a second term approved by a majority of voters and with the Republican Congress as his ally, Bush may also be able to push through medical liability reform.
When it comes to limiting malpractice awards, "There's a better chance with the Republican side," said James Hyde, president of 80-bed Bone & Joint Hospital in Oklahoma City, part of 23-hospital SSM Health Care. Despite that, he added, "Overall I think we still have a lot of battles to fight."
Among those battles are a growing number of uninsured and the possibility that deficit-reduction priorities will force Congress and the White House to look at hospital payments as a source of potential savings. Skyrocketing healthcare costs also represent a challenge that neither party effectively addressed during the campaign, some charge.
Medicare spent approximately $108.8 billion on hospital inpatient services in 2003 and approximately $49 billion on physician services.
Bush has opposed Democratic efforts to allow HHS to negotiate lower drug prices for Medicare beneficiaries, and is unlikely to change his stance on that now. Still, advocates hope the president will at least revisit reimportation of drugs from Canada and other steps that would improve access for the elderly.
Last year's Medicare Modernization Act added a prescription drug benefit for the first time, but the program has also been criticized by Democrats and seniors groups, who argue its benefits are inadequate and it gives too much money to managed-care plans.
"Parts of that bill were poorly written and (Bush) could really make seniors think he cared if he looked at it," said Barbara Kennelly, president of the National Committee to Preserve Social Security and Medicare.
That may be unlikely in the new political climate. In Congress, the balance of power shifted even more dramatically to the Republicans, who in January will control the Senate 55-45 and the House at least 231-200. Despite what may appear as an opportunity for Bush to advance a new healthcare agenda, some lobbyists expect little change.
"Bottom line, it's more of the same. In the end, healthcare was not a major issue with voters," said Rick Pollack, executive vice president of the American Hospital Association.
Other than briefly mentioning medical liability reform, Bush did not touch on healthcare issues in the first postelection press conference he held last week.
The Senate Finance Committee, which has jurisdiction over Medicare matters, will continue next year to monitor enactment of the prescription drug law and "work together to find solutions that lower health costs and improve access," Finance Committee Chairman Chuck Grassley (R-Iowa) said in a news release. "We need to ... have a thoughtful and careful debate on healthcare policy next year."
If the larger debate in Congress addresses growing budget deficits, providers could get stung by the lower Medicare payments that can result from cost-cutting, as they did by the Balanced Budget Act of 1997.
In a statement congratulating Bush on his victory last week, the American Medical Association said it looks forward to progress on medical liability reform and to addressing "the flawed Medicare payment formula that threatens to put seniors' access to care at risk."
HHS did not return calls seeking information on how long Secretary Tommy Thompson will stay in his slot. Rumors floated inside the Beltway last week that he is reconsidering his planned retirement after the Republicans' sweeping electoral victory.
Modern Healthcare will present a special section on the impact of the November election later this month. The section will be published in the Nov. 29 issue of the magazine. Our reporters will examine the election's impact on a variety of issues, including healthcare spending, Medicare, Medicaid, tort reform, information technology, patient safety and insurance coverage.